More and more policyholders use AI to appeal claims decisions. The appeals look alike, take longer to answer and put claims handlers under more pressure. Here’s what we’re seeing, why it matters and what insurers can do about it.
What we’re seeing
“Dear claims handler, I hope this email finds you well…”
If you work in claims, you already know which letter we’re talking about.
It opens with a polite summary of the case. Then come the numbered bullet points. Then references to specific wordings in the policy terms, a paragraph of consumer law and a list of reasons the decision should be reconsidered. It closes firmly but kindly, requesting a full review at your earliest convenience.
The message is always the same: the compensation is too low and the decision needs to be explained.
Across the insurers we work with, these appeals have become more common. Different policyholders, different claims, near-identical letters. Over the past few months, support tickets from claims handlers asking for help with appeals have almost doubled. Most of the appeals behind them are written with AI.
Why it’s a problem
It takes more time. An AI appeal takes minutes to write. Answering it takes much longer. AI is good at reading policy terms line by line and finding the small wordings, exceptions and possible loopholes that could support a higher payout. Each one has to be checked against the policy and answered properly, even when it doesn’t change the outcome.
It raises expectations. AI is good at telling people they have a strong case. When the decision stands, the claims handler is the one who has to explain why.
It’s a work environment issue. When every decision is questioned, it gets personal. If a compensation is based on a mix of systems, experience and gut feeling, the claims handler ends up defending themselves instead of the decision.
Claims handling was demanding long before AI. Now each appeal takes longer, the tone is sharper and the volume keeps growing. That load lands on the same people, case after case.
What helps: evidence
AI on the customer side is here to stay. The best defense is a decision that can be explained step by step:
↗ What the claim is about
↗ What the decision is based on
↗ Where the data comes from
↗ Which policy terms were applied
When claims handlers can show that, the discussion moves from the person to the facts. Appeals become quicker to answer and easier to close.
So should insurers fight AI with AI? Not with just any AI. Our CDO Anton Lind asked five popular LLMs to value a washing machine. They sounded convincing, but almost every answer had a wrong price, a product that couldn’t be bought, or both. Send that in reply to an appeal and you’ve got two chatbots arguing, with the claims handler stuck in the middle.
That’s where Upptec comes in. Every decision is backed by documented, reliable data that’s easy to access and understand. When an appeal comes in, the claims handler has a clear answer to point to.
“AI has made it easier than ever to question a claims decision. But it hasn’t made those questions any easier to answer. That’s why transparency and reliable data with easy access matter more than ever.”
— Linus Hemby, Customer Success Director at Upptec
More time where it matters
Clear evidence has the claims handler’s back. Less time defending routine decisions means more time for the claims where a human really makes a difference. And when policyholders can see what a decision was based on, they’re more likely to accept it. That builds trust in the insurer, even when the answer isn’t what they hoped for.
To summarize
Policyholders now have an assistant that never tires and writes like a lawyer. So who’s got the claims handler’s back?
We do. Every decision made with Upptec comes with the evidence behind it, so claims handlers can answer with facts and spend their time where people need them most.
Seeing the same thing in your claims team? Give us a call.
Upptec’s got your back.